摘要
目的探讨腓肠肌内侧头肌皮瓣转位修复胫骨中上段软组织缺损的临床效果。方法回顾性分析陕西中医药大学附属医院2016年9月至2020年6月收治的胫骨中上段组织缺损患者的临床资料。术前采用多普勒超声探测并标记下肢血管及分支,术中依据患者创面情况设计腓肠肌内侧头肌皮瓣,转位修复胫骨中上段组织缺损,术后对皮瓣外观、色泽、感觉、质地,步态和患足跖屈力量,以及供区恢复情况进行随访。对于慢性骨髓炎患者,术后参照McKee等骨髓炎治疗标准进行疗效评价,包括治愈、好转、复发3个级别。结果共纳入11例患者,男9例,女2例,年龄48~69岁。软组织缺损面积3.8 cm×5.7 cm~14.2 cm×7.6 cm,皮瓣切取面积13.0 cm×6.0 cm~21.0 cm×13.0 cm。术后有1例皮瓣下方出现积液、远端发生水疱,经对症处理后痊愈;其余皮瓣及供区创面血液循环良好,外形与功能恢复满意,切口一期愈合。11例术后随访7~18个月,平均13.2个月,皮瓣外观、色泽、质地基本满意;术后9个月皮瓣两点辨距觉为13~20 mm,平均15 mm;末次随访时患侧足跖屈力量比健侧减弱,但步态基本正常;4例慢性骨髓炎患者均达到临床治愈标准,在随访期间(平均14个月)原发病灶处无红肿热痛、破溃、渗出及窦道形成,X线检查均未见骨质硬化及死骨形成;供区无畸形及功能障碍,大腿皮片供区存在色素沉着,部分伴有浅表瘢痕。结论腓肠肌内侧头肌皮瓣转位修复胫骨中上段软组织缺损,不牺牲主干血管,皮瓣成活率高,并发症少,受区功能和形态恢复较好。
Objective To investigate the clinical outcome of transposition of the medial gastrocnemius muscle flap in repairing the middle and upper tibial soft tissue defects.Methods The clinical data of patients with mid-upper tibial tissue defects admitted to the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from September 2016 to June 2020 were retrospectively analyzed.Doppler ultrasound was used to detect and mark the blood vessels and branches of the lower limbs before surgery,the medial gastrocnemius muscle flap was designed according to the wound condition of the patient,the soft tissue defects in the middle and upper part of the tibia were repaired by transposition,and the appearance,color,feel,texture,gait and plantar flexion strength of the affected foot,as well as the recovery of the donor site were followed up after surgery.For patients with chronic osteomyelitis,the efficacy is evaluated with reference to McKee and other osteomyelitis treatment standards,including three levels:cure,improvement and recurrence.Results A total of 11 patients were enrolled,including 9 males and 2 females,aged 48 to 69 years.The area of soft tissue defect ranged 3.8 cm×5.7 cm-14.2 cm×7.6 cm,and the flap size ranged 13.0 cm×6.0 cm-21.0 cm×13.0 cm.After surgery,one case had blisters at the distal end,which were cured after conservative measures.Other flaps and donor wounds presented good blood circulation,the shape and function recovered satisfactorily,and the incision healed uneventfully.11 cases were followed up for 7-18 months after surgery,with an average of 13.2 months,and the appearance,color and texture of the flap were basically satisfactory.The two-point distance perception of the flap was 13-20 mm 9 months after surgery,with an average of 15 mm.At the last follow-up visit,the plantar flexion strength of the affected side was weaker than that of the healthy side,but the gait was basically normal.All 4 patients with chronic osteomyelitis met the clinical cure criteria,and there was no rash,swelling,overheat and pain,rupture,exudation and sinus tract formation at the primary lesion during the follow-up period(average 14 months),and no osteosclerosis and dead bone formation were found on X-ray examination.There was no deformity and dysfunction at the donor site.There was one case presented pigmentation at the donor site of the thigh.Some cases presented superficial scarring.Conclusions The transposition of the medial gastrocnemius muscle flap repairs the middle and upper tibial tissue defects without sacrificing the major blood vessels,and the flap survival rate is high,the complications are minimal,and the function and morphological recovery of the receiving area are good.
作者
孙钰
杨利学
谭龙旺
仇永锋
Sun Yu;Yang Lixue;Tan Longwang;Qiu Yongfeng(Second Department of Orthopedics,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China)
出处
《中华整形外科杂志》
CSCD
2022年第12期1333-1339,共7页
Chinese Journal of Plastic Surgery
基金
国家自然科学基金(81774349)
陕西省自然科学基础研究计划(2018JM7128)
陕西省教育厅项目(18JK0210)
关键词
外科皮瓣
腓肠肌内侧头肌皮瓣
胫骨中上段
软组织缺损
Surgical flaps
Medial gastrocnemius muscle flap
Middle and upper tibia
Soft tissue defect
